Abstract
BackgroundSouth Africa did not meet the MDG targets to reduce TB prevalence and mortality by 50% by 2015, and the TB cure rate remains below the WHO target of 85%. TB incidence in the country is largely fuelled by the HIV epidemic, and co-infected patients are more likely to have unsuccessful TB treatment outcomes. This paper analyses the demographic and clinical characteristics of new TB patients with unsuccessful treatment outcomes, as well as factors associated with unsuccessful treatment outcomes for HIV co-infected patients.MethodsA cross-sectional retrospective record review of routinely collected data for new TB cases registered in the Free State provincial electronic TB database between 2009 and 2012. The outcome variable, unsuccessful treatment, was defined as cases ≥15 years that ‘died’, ‘failed’ or ‘defaulted’ as the recorded treatment outcome. The data were subjected to descriptive and logistic regression analyses.ResultsFrom 2009 to 2012 there were 66,940 new TB cases among persons ≥15 years (with a recorded TB treatment outcome), of these 61% were co-infected with HIV. Unsuccessful TB treatment outcomes were recorded for 24.5% of co-infected cases and 15.3% of HIV-negative cases. In 2009, co-infected cases were 2.35 times more at risk for an unsuccessful TB treatment outcome (OR: 2.35; CI: 2.06-2.69); this figure decreased to 1.8 times by 2012 (OR: 1.80; CI: 1.63-1.99). Among the co-infected cases, main risk factors for unsuccessful treatment outcomes were: ≥ 65 years (AOR: 1.71; CI: 1.25-2.35); receiving treatment in healthcare facilities in District D (AOR: 1.15; CI 1.05-1.28); and taking CPT (and not ART) (AOR: 1.28; CI: 1.05-1.57). Females (AOR: 0.93; CI: 0.88-0.99) and cases with a CD4 count >350 (AOR: 0.40; CI: 0.36-0.44) were less likely to have an unsuccessful treatment outcome.ConclusionsThe importance of TB-HIV/AIDS treatment integration is evident as co-infected patients on both ART and CPT, and those who have a higher CD4 count are less likely to have an unsuccessful TB treatment outcome. Furthermore, co-infected patients who require more programmatic attention are older people and males.
Highlights
South Africa did not meet the Millenium development goal (MDG) targets to reduce TB prevalence and mortality by 50% by 2015, and the TB cure rate remains below the World Health Organization (WHO) target of 85%
Univariate odds ratios revealed that in 2009, the TB-human immunodeficiency virus (HIV) co-infected cases were 2.35 times more at risk for an unsuccessful TB treatment outcome (OR: 2.35; confidence intervals (CIs): 2.06-2.69) than the HIV negative cases; this figure decreased to 1.8 times in 2012 (OR: 1.80; CI: 1.63-1.99)
Despite WHO [30] guidelines that Cotrimoxazole prophylaxis (CPT) should be initiated prior to antiretroviral treatment (ART), our study found that patients who were only on CPT and not on a combination of ART and CPT, were at an increased risk of an unsuccessful treatment outcome
Summary
South Africa did not meet the MDG targets to reduce TB prevalence and mortality by 50% by 2015, and the TB cure rate remains below the WHO target of 85%. Research has found that the initiation of ART during TB treatment significantly improves the chance of survival [5, 8,9,10,11,12,13,14,15]. For these reasons, integration of TB and HIV services is widely advocated [16,17,18,19,20]. While there is a policy commitment to provide integrated TB and HIV services in South Africa, the reality is that services remain largely fragmented and provided in silos [21]
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